Prevalence of airway symptoms among hairdressers in Bergen, Norway

OBJECTIVE—To assess respiratory symptoms among hairdressers in Norway.
METHODS—The study was based on a questionnaire sent to 100 hairdressers (91% responding) and 95 office workers (84% responding). The questionnaire sought information about allergy, respiratory symptoms in the past year, and symptoms after exposures to different types of pollutants, working conditions, and smoking habits. A population based control group was established because the hairdressers and office workers differed in age and smoking habits.
RESULTS—The prevalence of respiratory symptoms in the past year did not differ significantly between hairdressers and office workers after adjusting for age, atopy, and smoking. The hairdressers over 40 years of age reported significantly more symptoms—such as wheezing and breathlessness—in the past year than the office workers of the same age. Compared with the population based control group, both hairdressers younger than 30 and those over 40 reported more symptoms—such as breathlessness in the past year. The oldest hairdressers reported such symptoms as wheezing and breathlessness more often than did the younger hairdressers. These differences in breathlessness were significant after adjusting for smoking and wheezing. The same trend was not found among the office workers. The hairdressers reported significantly more wheezing, breathlessness, runny eyes, and blocked or runny nose from exposure to hair dyes, permanent oils, bleaching powder, and other chemicals used in a hairdressing salon, compared with the office workers. Prevalence of symptoms during exposure to other types of generel pollutants was similar in the two groups.
CONCLUSIONS—Hairdressers are exposed to low levels of various irritating chemicals every day. The prevalences of acute symptoms related to the exposure of hairdressers to hairdressing chemicals are very high. Hairdressers, especially the oldest hairdressers, have more asthma-like symptoms than the control groups.


Keywords: hairdresser; allergy; asthma     

Relation between immune variables and burnout in a sample of physicians

OBJECTIVES—To evaluate in a group of physicians the relation between burnout, demographic or job characteristics, anxiety, and immune variables.
METHODS—Seventy one physicians of all grades were recruited among different departments to a cross sectional survey. The Maslach burnout inventory, scales of emotional exhaustion, depersonalisation, and personal accomplishment, the trait scale of anxiety inventory (STAI-Y2), and a questionnaire on personal and professional characteristics were administered. The immune profile included quantitative (number (%) of lymphocytes and subsets) and functional (natural killer cytotoxicity) measures.
RESULTS—With a model of stepwise multiple regression analysis, emotional exhaustion was significantly affected by both personal (marital, sex) and job characteristics (qualification, working activity), whereas only patient contact explained a portion of variation in depersonalisation. Furthermore, trait anxiety was found to predict the Maslach burnout inventory scores. After correction for potential confounders, physicians who scored high levels of personal accomplishment showed significantly higher numbers of total lymphocytes, T cells (CD3), T helper cells (CD4), and T suppressor cells (CD8) than those who scored low levels. No other correlation was found between burnout and immune variables.
CONCLUSIONS—In our group of relatively young physicians a high degree of personal accomplishment was associated with an increase in the number of peripheral lymphocytes, particularly T subsets. The meaning of this is not clear, although it could be speculated that to evaluate oneself positively, particularly with regard to work with patients in the health services, might help to stimulate the immune system. By contrast, there is no evidence that to work hard, to feel tired from work, and to have a cynical reaction towards patient care is related to immunosuppression.


Keywords: burnout; physicians; immune variables     

Incidence of cancer among bookbinders, printers, photoengravers, and typesetters

OBJECTIVES—To to study the risk of cancer, particularly of lung cancer and bladder cancer, among workers in the printing industry according to different occupations.
METHODS—This is a population based retrospective cohort study. The cohort comprised 1332 men and 426 women employed in the printing industry in Iceland according to a published union registry. A computerised file of the cohort was record linked to the Cancer Registry by making use of personal identification numbers. Expected numbers of cases of cancer were calculated on the basis of number of person-years and specific incidences of cancer sites for men and women provided by the Cancer Registry.
RESULTS—Among the men (36 217.5 person-years at risk) there were 125 observed cancers versus 123.66 expected, standardised incidence ratio (SIR) 1.01, 95% confidence interval (95% CI) was 0.84 to 1.20. The SIR (95% CI) for liver cancer was 1.97 (0.55 to 5.20) and the SIR for non-Hodgkin's lymphoma was 2.26 (0.96 to 4.41). No excess risk for cancer was found among women (8631.0 person-years at risk). The SIR (95% CI) for liver cancer was 4.21 (0.47 to 15.20) and for non-Hodgkin's lymphoma it was 4.99 (1.61 to 11.63) among the typesetters. A survey on smoking habits among active and retired union members showed that they smoked less than a random sample of the general population.
CONCLUSION—The cancer site most often reported to show excess risk among printing industry workers has been the lung and the urinary bladder; however, this was not found in the present study. This may be explained by difference in smoking habits among union members compared with the general population. There is a high occurrence of non-Hodgkin's lymphoma, particularly among typesetters, which warrants further studies.


Keywords: printing industry; non-Hodgkin's lymphoma; smoking habits     

Physical, psychosocial, and organisational factors relative to sickness absence: a study based on Sweden Post

OBJECTIVE—To analyse incidence of sickness for women and men relative to potential aetiological factors at work—physical, psychosocial, and organisational.
METHODS—The study group comprised 1557 female and 1913 male employees of Sweden Post. Sickness absence was measured by incidence of sickness (sick leave events and person-days at risk). Information on explanatory factors was obtained by a postal questionnaire, and incidence of sickness was based on administrative files of the company.
RESULTS—Complaints about heavy lifting and monotonous movements were associated with increased risk of high incidence of sickness among both women and men. For heavy lifting, an odds ratio (OR) of 1.70 (95% confidence interval (95% CI) 1.22 to 2.39) among women, and OR 1.70 (1.20 to 2.41) among men was found. For monotonous movements the risk estimates were OR 1.42 (1.03 to 1.97) and OR 1.45 (1.08 to 1.95) for women and men, respectively. Working instead of taking sick leave when ill, was more prevalent in the group with a high incidence of sickness (OR 1.74 (1.30 to 2.33) for women, OR 1.60 (1.22 to 2.10) for men). Overtime work of more than 50 hours a year was linked with low incidence of sickness for women and men. Among women, 16% reported bullying at the workplace, which was linked with a doubled risk of high incidence of sickness (OR 1.91 (1.31 to 2.77)). For men, the strongest association was found for those reporting anxiety about reorganisation of the workplace (OR 1.93 (1.34 to 2.77)).
CONCLUSIONS—Certain physical, psychosocial, and organisational factors were important determinants of incidence of sickness, independently of each other. Some of the associations were sex specific.


Keywords: incidence of sickness; work environment; sex     

Reactivity and recovery from different types of work measured by catecholamines and cortisol: a systematic literature overview

OBJECTIVES—To review occupational health, laboratory, and sports literature on neuroendocrine reactivity and recovery from mental, combined mental and physical, or physical tasks.
METHODS—A systematic literature search was performed in eight databases. Studies with catecholamines or cortisol as effect variables measured in blood, urine, or saliva were included.
RESULTS—After application of inclusion and exclusion criteria, 77 studies from the initial 559 identified were taken into account. In occupational settings it was found that relatively few studies were conclusive about recovery, which formed a contrast with sports research. For reactivity and recovery up to 1 hour after performing the task, half of the studies considered physical tasks and more than two thirds showed incomplete recovery compared with baseline excretion of catecholamines and cortisol. Recovery extending to 3 days after the task was performed was often incomplete for cortisol after combined mentally and physically demanding tasks, and less often after solely mental or physical tasks. This type of recovery was more often incomplete for adrenaline (epinephrine) than for noradrenaline (norepinephrine), which was the case after mental as well as combined mental and physical tasks.
CONCLUSIONS—The results from laboratory and sports research may be transferable to some occupations, but more research is needed on the course of recovery relative to health effects in occupational settings.


Keywords: neuroendocrine reactivity; neuroendocrine recovery; occupational task     

Vibration exposure, smoking, and vascular dysfunction

OBJECTIVES—Vibration white finger (VWF), also known as "occupational Raynaud's phenomenon", is marked by arterial hyperresponsiveness and vasoconstriction during cold stimulation. The impact of tobacco use, and by extension stopping smoking, on the long term course of the disease has been inconclusively characterised. The objectives of this study included assessment of the impact of tobacco use on symptoms and on objective tests in shipyard workers exposed to vibration, and in gauging the natural history of the disorder after stopping exposure and changing smoking patterns.
METHODS—In a cross sectional investigation, 601 current and former users of pneumatic tools were evaluated subjectively for cold related vascular symptoms, and tested by cold challenge plethysmography. There was follow up and subsequent testing of 199 members of the severely effected subgroup of smokers and non-smokers, many of whom had stopped smoking in the interval between tests. Effects of smoking and stopping smoking on symptoms and plethsymographic results were assessed.
RESULTS—Symptoms and measured abnormal vascular responses related to cold were more severe in smokers than in non-smokers. Follow up of 199 severely effected members of the cohort, all removed from exposure for 2 years, indicated that smokers were almost twice as likely to have more severe vasospasm (test finger/control finger systolic blood pressure% (FSBP%) <30) than were non-smokers (−32.2% v 17.4%). 53 Subjects who stopped smoking during the interval between tests improved, and were indistinguishable from non-smokers similarly exposed to vibration. Additional physiological benefits of stopping smoking were still apparent at further follow up examination, 1 year later. Improvements evident on plethysmography were not accompanied by improvements in symptoms, which were unaffected by smoking.
CONCLUSIONS—Smoking seems to delay physiological improvement in response to cold challenge in workers with VWF, after the end of exposure to vibration. Symptoms were less likely to improve over time than digital blood pressure, and were less affected by smoking.


Keywords: vibration white finger; cold challenge plethysmography; smoking; Raynaud's phenomenon     

Effects of drop out in a longitudinal study of musculoskeletal disorders

OBJECTIVES—The drop out rates in different longitudinal studies of musculoskeletal disorders range between 7% and 57%, and little is known about the characteristics of the subjects who dropped out. The aim was to analyse various consequences of drop out in a longitudinal study of musculoskeletal disorders and occupational risk factors during 1969-97.
METHOD—Data about occupational conditions and health in 1969 and in 1993 were analysed. Differences between those who participated throughout (participants) and drop out subjects in these analyses formed the basis for recalculations of earlier reported analyses of associations between occupational conditions and low back pain. In the recalculation the data were weighted to compensate for the differences.
RESULTS—More female and male drop out subjects than participants in 1993 had monotonous work, fewer women and more male drop out subjects had heavy lifting in 1969. In 1997, more female and male drop out subjects had had heavy lifting and low stimulation at work in 1993. At both occasions, there were differences between the drop out subjects and participants in occurrence of musculoskeletal disorders. The weighted analyses resulted in changes in risk ratio of 0.1-0.2.
CONCLUSIONS—Differences in occupational conditions and health among participants and drop out subjects in a longitudinal study of musculoskeletal disorders and occupational risk factors during 1969-97 did not markedly influence the risk ratios.


Keywords: panel study; non-response; survey method; methodological study     

Workplace exposures and oesophageal cancer

OBJECTIVES—To describe the relation between oesophageal cancer and many occupational circumstances with data from a population based case-control study.
METHODS—Cases were 99 histologically confirmed incident cases of cancer of the oesophagus, 63 of which were squamous cell carcinomas. Various control groups were available; for the present analysis a group was used that comprised 533 population controls and 533 patients with other types of cancer. Detailed job histories were elicited from all subjects and were translated by a team of chemists and hygienists for evidence of exposure to 294 occupational agents. Based on preliminary results and a review of literature, a set of 35 occupational agents and 19 occupations and industry titles were selected for this analysis. Logistic regression analyses were adjusted for age, birthplace, education, respondent (self or proxy), smoking, alcohol, and β-carotene intake.
RESULTS—Sulphuric acid and carbon black showed the strongest evidence of an association with oesophageal cancer, particularly squamous cell carcinoma. Other substances showed excess risks, but the evidence was more equivocal—namely chrysotile asbestos, alumina, mineral spirits, toluene, synthetic adhesives, other paints and varnishes, iron compounds, and mild steel dust. There was considerable overlap in occupational exposure patterns and results for some of these substances may be mutually confounded. None of the occupations or industry titles showed a clear excess risk; the strongest hints were for warehouse workers, food services workers, and workers from the miscellaneous food industry.
CONCLUSIONS—The data provide some support for an association between oesophageal cancer and a handful of occupational exposures, particularly sulphuric acid and carbon black. Many of the associations found have never been examined before and warrant further investigation.


Keywords: oesophageal cancer; occupational exposures; occupations     

Functional variables associated with the clinical grade of dyspnoea in coal miners with pneumoconiosis and mild bronchial obstruction

OBJECTIVES—Dyspnoea is a common symptom in coal miners with pneumoconiosis. Among others, gas exchange disturbances due to airway obstruction or mismatch between ventilation and perfusion may be underlying mechanisms. The validation of dyspnoea by the degree of airway obstruction is controversial, because the extent of airway obstruction often does not correlate with the clinical grade of breathlessness.
METHODS—The association was investigated between breathlessness (self reported, on a six point scale) and indices of submaximal spiroergometry in 66 coal workers with radiographically confirmed pneumoconiosis (International Labour Organisation (ILO) grade of profusion 1/0, mean (SD) age 64 (5.5) years, mean (SD) forced expired volume in 1 second (FEV₁) 77.5 (22.9) % predicted).
RESULTS—The clinical degree of breathlessness was independently associated with minute ventilation/oxygen consumption (E/O₂) ratio (β 0.423, 95% confidence interval (95% CI) 0.18 to 0.67, p=0.001) and smoking (β 0.318, 95% CI 0.21 to 1.79, p=0.014) in a multiple linear regression analysis. The E/O₂ ratio (β 0.556, 95% CI 0.20 to 0.90, p=0.003) was also the best predictor of breathlessness when only coal miners with airway obstruction (FEV₁ < 80% predicted) were analyzed.
CONCLUSION—The E/O₂ ratio as a measurement of mismatch between ventilation and perfusion predicted the clinical grade of breathlessness better than measurements of bronchial obstruction at rest in coal workers with pneumoconiosis.


Keywords: coal workers' pneumoconiosis; bronchial obstruction; ventilation     

Prognostic factors for respiratory sickness absence and return to work among blue collar workers and office personnel

OBJECTIVES—To analyze factors that determine the occurrence of sickness absence due to respiratory disorders and the time it takes to return to work.
METHODS—A longitudinal study with 2 year follow up was conducted among 326 male blue collar and white collar workers. The survey started with an interview on respiratory complaints and spirometry. Sixty six (21%) workers were lost to follow up. Complete data on sickness absence among 251 workers during the follow up were collected from absence records and self reports. Regression analysis based on a proportional hazards model was applied to identify risk factors for the occurrence and duration of sickness absence due to respiratory disorders.
RESULTS—During the follow up 35% workers attributed at least one period of sickness absence to respiratory complaints, which accounted for 14.2% of all days lost. A history of chronic obstructive pulmonary disease (COPD) did not predict sickness absence for COPD; the same was true for chronic non-specific lung disease (CNSLD). Complaints about asthma contributed significantly to absence due to asthma (relative risk (RR) 3.96; 95% confidence interval (95% CI) 1.99 to 7.90). Job title was a significant predictor of sickness absence due to respiratory complaints. Decrease in forced vital capacity (FVC, <80% of the reference value) was also a significant predictor of absence due to asthma (RR 4.03; 95% CI 1.41 to 11.54) and of respiratory absence (RR 2.49; 95% CI 1.07 to 5.79). Absence with respiratory complaints was not associated with age, height, body mass index, or smoking. Duration of employment was a weak almost significant predictor against respiratory absenteeism (RR 0.94; 95% CI 0.91 to 0.97). Return to work after respiratory absence was worse for blue collar workers than office personnel (RR 5.74; 95% CI 1.90 to 17.4 for welders, and RR 6.43; 95% CI 2.08 to 19.85 for metal workers).
CONCLUSIONS—Asthmatic complaints in the 12 months before the study were associated with sickness absence for these complaints during the follow up. An abnormal level of FVC also influenced respiratory absenteeism. Blue collar workers had more often and more prolonged absences due to respiratory disorders than white collar workers. Workers with absence due to respiratory complaints were at higher risk of subsequent sickness absence in the next year.


Keywords: respiratory complaints; sickness absence; return to work     

Mortality in chemical workers potentially exposed to 2,4-dichlorophenoxyacetic acid (2,4-D) 1945-94: an update

OBJECTIVE—To update and add to a previously identified cohort of employees potentially exposed to the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). The putative association between 2,4-D and non-Hodgkin's lymphoma has been debated for more than a decade.
METHODS—Cohort members were male employees of The Dow Chemical Company who manufactured or formulated 2,4-D any time from 1945 to the end of 1994. Their mortality experience was compared with national rates and with more than 40 000 other company employees who worked at the same location.
RESULTS—330 Deaths were observed among 1517 people compared with 365 expected (standardised mortality ratio (SMR)=0.90, 95% confidence interval (95% CI) 0.81 to 1.01). There were no significantly increased SMRs for any of the causes of death analyzed. When compared with the United States rates, the SMR for non-Hodgkin's lymphoma (NHL) was 1.00 (95% CI 0.21 to 2.92). The internal comparison with other Dow employees showed a non-significant relative risk of 2.63, (95% CI 0.85 to 8.33). Death was attributed to amyotrophic lateral sclerosis (ALS) for three cohort members. Compared with the other company employees, the relative risk was 3.45 (95% CI 1.10 to 11.11). The cases were employed in the manufacture or formulation of 2,4-D at different periods (1947-9, 1950-1, and 1968-86), and for varying durations of time (1.3, 1.8, and 12.5 years).
CONCLUSION—There was no evidence of a causal association between exposure to 2,4-D and mortality due to all causes and total malignant neoplasms. No significant risk due to NHL was found. Although not an initial hypothesis, an increased relative risk of ALS was noted. This finding is unsupported by other animal and human studies.


Keywords: 2,4-dichlorophenoxyacetic acid; phenoxy herbicide; occupation; non-Hodgkin's lymphoma     

Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27 485 people

OBJECTIVES—To explore how metabolic risk factors for cardiovascular disease (CVD) differ between shift workers and day workers in a defined population. Shift work has been associated with an increased risk of CVD. Risk factors and causal pathways for this association are only partly known.
METHODS—A working population of 27 485 people from the Västerbotten intervention program (VIP) has been analysed. Cross sectional data, including blood sampling and questionnaires were collected in a health survey.
RESULTS—Obesity was more prevalent among shift workers in all age strata of women, but only in two out of four age groups in men. Increased triglycerides (>1.7 mmol/l) were more common among two age groups of shift working women but not among men. Low concentrations of high density lipoprotein (HDL) cholesterol (men<0.9 and women<1.0 mmol/l) were present in the youngest age group of shift workers in both men and women. Impaired glucose tolerance was more often found among 60 year old women shift workers. Obesity and high triglycerides persisted as risk factors in shift working men and women after adjusting for age and socioeconomic factors, with an OR of 1.4 for obesity and 1.1 for high triglyceride concentrations. The relative risks for women working shifts versus days with one, two, and three metabolic variables were 1.06, 1.20, and 1.71, respectively. The corresponding relative risks for men were 0.99, 1.30, and 1.63, respectively.
CONCLUSIONS—In this study, obesity, high triglycerides, and low concentrations of HDL cholesterol seem to cluster together more often in shift workers than in day workers, which might indicate an association between shift work and the metabolic syndrome.


Keywords: shift work; metabolic variables; coronary heart disease     

Dermal in vitro penetration of methiocarb, paclobutrazol, and pirimicarb

OBJECTIVES—The dominant route of occupational exposure to pesticides in horticulture is dermal. However, preventive measures are seldom used when handling plant cultures recently treated with pesticides, thus causing significant dermal exposure and potential absorption. Assessment of exposure often depends on biological monitoring of blood or urine samples. The skin often acts as a temporary reservoir for chemicals before absorption. Failure to consider the lag time between dermal exposure and appearance of pesticide or metabolites in the general circulation may lead to false conclusions about assessment of exposure.
METHODS—In an experimental model in which in vitro static diffusion cells were mounted with human skin, dermal penetration of three extensively used pesticides (methiocarb, paclobutrazol, pirimicarb) was evaluated.
RESULTS—Pirimicarb and paclobutrazol had comparable rates of dermal penetration and lag times of around 18 hours. Methiocarb had a considerably shorter lag time. Dermal penetration continued for extended periods after exposure had ended.
CONCLUSIONS—With lag times sometimes considerably longer than a normal working day, biological monitoring at the end of exposure may seriously underestimate the actual exposure. There may be implications for regulatory guidelines, which often require only 24 hour observation periods.


Keywords: dermal penetration; pesticides; in vitro     

Musculoskeletal dysfunction in physical education teachers

OBJECTIVES—To investigate the prevalence of musculoskeletal disorders, especially symptomatic osteoarthrosis (OA) of the knee and hip, health and lifestyle factors among physical education (PE) teachers, and whether they differed from the general population in these respects.
METHODS—The study base was all Swedish men (n=290) and women (n=281) who graduated from the only training college for PE teachers in Sweden, between the years 1957 and 1965, and age matched referents, 255 men and 257 women, randomly selected from the Swedish population register. A postal questionnaire was sent to the subjects with questions on occupational history, participation in sports, musculoskeletal disorders, height, weight, smoking habits, and general health.
RESULTS—The PE teachers had a higher prevalence ratio (PR) of symptomatic OA of the knee (men: 2.8 95% confidence interval (95% CI) 1.6 to 4.8; women: 3.2 95% CI 1.8 to 5.5) and knee injury compared with the referents. The PE teachers reported more absence from work, and the women had had to change jobs more often because of knee disorders. The prevalence ratio for symptomatic OA of the hip was 2.7 (95% CI 1.0 to 7.1) for the female PE teachers. At the age of 25 the body mass index (BMI) of male PE teachers was higher than the male referents, but at an older age both the female and male PE teachers had lower BMI than the referents. The participation in sports activities was considerably higher in the group of PE teachers. They also smoked less, reported less serious diseases, and better health than the referents.
CONCLUSIONS—The PE teachers had a high risk of developing knee disorders, which entailed difficulties in continuing their work as PE teachers. They differed from the referents in lifestyle factors as they smoked less, were less overweight, and had a higher lifelong sports exposure.


Keywords: body mass index; hip osteoarthrosis; knee osteoarthrosis     

Non-Hodgkin's lymphoma among electric utility workers in Ontario: the evaluation of alternate indices of exposure to 60 Hz electric and magnetic fields

OBJECTIVES—To examine associations between non-Hodgkin's lymphoma (NHL) and exposures to 60 Hz magnetic and electric fields in electric utility workers with a series of indices that capture a variety of aspects of field strength.
METHODS—The study population consisted of 51 cases of NHL and 203 individually matched controls identified from within a cohort of male electric utility workers in Ontario. Odds ratios were calculated for several exposure indices with conditional logistic regression models. Aspects of exposure to electric and magnetic fields that were modelled included: the percentage of time spent above selected threshold field intensities, mean transitions in field strength, SD, and the arithmetic and geometric mean field intensities.
RESULTS—For the most part, there was a lack of an association between exposure indices of magnetic fields and the incidence of NHL. Subjects in the upper tertile of percentage of time spent above electric field intensities of 10 and 40 V/m had odds ratios of 3.05 (95% confidence interval (95% CI) 1.07 to 8.80) and 3.57 (1.30 to 9.80), respectively, when compared with those in the lowest tertile. Moreover, the percentages of time spent above these electric field thresholds were significant predictors of case status over and above the association explained by duration of employment and the arithmetic or geometric mean exposure.
CONCLUSIONS—These data suggest that exposures above electric field threshold intensities of 10 and 40 V/m are important predictors of NHL. Consequently, the findings support the hypothesis that electric fields may play a promoting part in the aetiology of this cancer. Further occupational studies that include assessment of exposure to electric fields and measures of field strength above similar threshold cut off points are needed to confirm these findings.


Keywords: non-Hodgkin's lymphoma; electric fields; magnetic fields     

Hepatitis A in workers exposed to sewage: a systematic review

OBJECTIVES—To assess whether the scientific literature supports the hypothesis that workers exposed to sewage are at higher risk of hepatitis A (HA).
METHODS—All original papers reporting epidemiological studies published in English, French, or German which reported on the risk of HA infection in workers exposed to sewage were eligible. They were identified by several methods and each original paper was assessed independently with a checklist by two people. Studies were classified according to the strength of their design. Non-eligible studies were also examined to assess the impact of publication bias. If the risk estimates diverged widely, causes for heterogeneity were assessed. A distinction was made between seroprevalence studies based on subclinical HA (defined only by the presence of anti-HA antibodies) and clinical HA.
RESULTS—17 eligible studies were identified. No indication of an increased risk of clinical HA could be found. For seroprevalence the studies with the strongest design suggested a slightly increased risk of subclinical HA with an odds ratio (OR) <2.5. Heterogeneity was considerable and precluded a meta-analysis. Considering non-eligible studies would still decrease the OR.
CONCLUSIONS—The systematic review does not confirm an increased risk of clinical HA in workers exposed to sewage. An increased risk of subclinical HA cannot be excluded but the association between seropositivity and exposure to sewage was not strong and became still weaker if publication bias was taken into account.


     

Prospective study of hepatic, renal, and haematological surveillance in hazardous materials firefighters

OBJECTIVES—To evaluate possible health effects related to work with hazardous materials as measured by end organ effect markers in a large cohort over about 2 years, and in a subcohort over 5 years.
METHODS—Hepatic, renal, and haematological variables were analysed from 1996-98 in hazardous materials firefighters including 288 hazardous materials technicians (81%) and 68 support workers (19%). The same end organ effect markers in a subcohort of the technicians were also analysed (n=35) from 1993-98. Support workers were considered as controls because they are also firefighters, but had a low potential exposure to hazardous materials.
RESULTS—During the study period, no serious injuries or exposures were reported. For the end organ effect markers studied, no significant differences were found between technicians and support workers at either year 1 or year 3. After adjustment for a change in laboratory, no significant longitudinal changes were found within groups for any of the markers except for creatinine which decreased for both technicians (p<0.001) and controls (p<0.01).
CONCLUSIONS—Health effects related to work are infrequent among hazardous materials technicians. Haematological, hepatic, and renal testing is not required on an annual basis and has limited use in detecting health effects in hazardous materials technicians.


Keywords: hazardous materials; firefighters; medical surveillance     

Work disability and productivity loss in patients with inflammatory bowel diseases in Hungary in the era of biologics

Background and aims

To assess work disability (WD) rates in an inflammatory bowel disease (IBD) cohort involving patients with Crohn’s disease (CD) or ulcerative colitis (UC) cohort and to identify possible clinical or demographic factors associated with WD. To our knowledge, this is the first study from Eastern Europe that has estimated indirect costs in IBD.

Methods

Data from 443 (M/F: 202/241, CD/UC: 260/183, mean age: 35.5 (CD) and 40.5 (UC) years, biological drug exposure 31.2/11.5 %) consecutive patients were included. WD data were collected by questionnaire and the work productivity and activity impairment instrument. Disability pension (DP) rates in the general population were retrieved from public databases.

Results

The overall DP rate in this IBD population was 32.3 %, with partial disability in 24.2 %. Of all DP events, 88.8 % were directly related to IBD. Overall, full DP was more prevalent in IBD (RR: 1.51, p < 0.001) and CD (RR: 1.74, p < 0.001) but not in UC compared to the general population and also in CD compared to UC (OR 1.57, p = 0.03). RR for full DP was increased only in young CD patients (RR_{<35 year olds}: 9.4; RR_{36–40 year olds}: 9.4 and 5.6, p < 0.01 for both). In CD, age group, previous surgery, disease duration, frequent relapses, and the presence of arthritis/arthralgia were associated with an increased risk for DP. Among employed patients, absenteeism and presenteeism was reported in of 25.9 and 60.3 % patients, respectively, leading to a 28 % loss of work productivity and a 32 % activity loss, and was associated with disease activity and age group. Average cost of productivity loss due to disability and sick leave with a human capital approach was 1,450 and 430 €/patient/year in IBD, respectively (total productivity loss 1,880 €/patient/year), the costs of presenteeism were 2,605 (SD = 2,770) and 2,410 (SD = 2,970) €/patient/year in CD and UC, respectively.

Conclusion

Risk of DP was highly increased in young CD patients (sixfold to ninefold). Previous surgery and presence of arthritis/arthralgia was identified as risk factors for DP. Work productivity is significantly impaired in IBD and is associated with high productivity loss.

     

Changes in frequency of premature complexes and heart rate variability related to shift work

OBJECTIVES—To investigate whether an increased risk of cardiovascular disease might be caused by increased arrhythmogeneity and by unfavourable changes in autonomic cardiac control the changes in the occurrence of premature complexes (PVCs) and in heart rate variability (HRV) were studied in subjects who started to work in shifts.
METHODS—1 Year changes in frequency of PVCs and HRV were measured in 49 shift workers and 22 control subjects working in daytime. All respondents were starting in a new job in integrated circuit or waste incinerator plants.
RESULTS—The incidence of PVC increased significantly in shift workers over the 1 year follow up, compared with daytime workers. The frequency of ventricular extrasystoles increased in 48.9% of the shift workers, and in 27.3% of the daytime workers. The Spearman correlation coefficient between the number of nights worked and the change in PVCs was 0.33 (p=0.004). A small non-significant unfavourable change in HRV was found in both the shift and daytime workers.
CONCLUSIONS—A change in arrhythmogeneity, but not in cardiac autonomic control, might explain the increased risk of cardiovascular disease in shift workers.


Keywords: arrhythmia; heart rate; shift work     

Fatigue among working people: validity of a questionnaire measure

OBJECTIVES—To evaluate the validity of the checklist individual strength questionnaire (CIS) in the working population. This 20 item self reported questionnaire has often been used in patients with chronic fatigue. To date, no research has focused on the validity of the CIS in occupational groups.
METHODS—To evaluate the discriminant validity the CIS was filled out by five groups of employees with expected differences in fatigue. The convergent validity was evaluated by comparing the results of the CIS with the results of three related measures: measured unidimensional fatigue, burnout, and need for recovery.
RESULTS—The CIS was able to discriminate between fatigued and non-fatigued employees in occupational groups. The expected agreement between the results of the CIS and related measures was confirmed.
CONCLUSIONS—The CIS seems to be an appropriate instrument for measuring fatigue in the working population.


Keywords: fatigue; occupational groups; measurement